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Four Most Important Facts About Thyroid Cysts

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Thyroid cysts are quite common and are almost always benign.  Large thyroid cysts can become very noticeable and be symptomatic simply because of their size.  There have been many approaches to manage thyroid cysts over time.  In some circumstances, surgery or ablative approaches are indicated when thyroid cysts are large or causing symptoms.

The Four Most Important Facts About Thyroid Cysts

#1 Most Important Fact About Thyroid Cysts: Almost all thyroid cysts are benign

Pure thyroid cysts are almost uniformly benign.  Therefore the concern for a thyroid cancer is routinely minimized. Thyroid  cysts are full of fluid that contains a material called colloid.  Colloid filled thyroid cysts contain a small protein that is found within normal thyroid glands called thyroglobulin.  If a person checks their blood for this same protein, it will often be elevated above normal levels.  Thyroid cysts may be found as an isolated finding or individuals may have multiple thyroid cysts. 

#2 Most Important Fact About Thyroid Cysts: Thyroid medication or aspiration of the fluid component of the cyst does not resolve the cyst

When thyroid cysts become large, they can become visible or cause symptoms most commonly a sense of a lump in the throat or changes in swallowing.  Over the years, giving patients thyroid hormone to attempt to reduce the production of the fluid center of the thyroid cyst have been used and uniformly found to be ineffective.  In addition, aspiration of the cyst fluid temporarily reduces the cyst volume and thyroid cyst symptoms, however return of the thyroid cyst content is almost uniformly observed. 

#3 Most Important Fact About Thyroid Cysts: Ablation of thyroid cysts can control symptomatic thyroid cysts in some circumstances

Ablation of thyroid cysts has been shown to have varying degrees of success over the years.  In the past, alcohol ablation of thyroid cysts has been used but has decreased in its therapeutic enthusiasm.  In order to effectively ablate a thyroid cyst, a majority of the cyst content needs to be removed with aspiration and then alcohol is then delivered into the thyroid cyst.  Another more recent ablative technique called RFA (radiofrequency ablation) has been developed.  This technique also uses ultrasound to visualize the thyroid cyst and then deliver a radiofrequency to kill or ablate the cells which line and produce the cyst.  The benefit of both of these approaches is that normal thyroid tissue can be spared.

#4 Most Important Fact About Thyroid Cysts: Partial thyroid surgery effectively removes symptomatic thyroid cysts

Thyroid cysts which are large and visibly noticeable or causing other symptoms may present for surgery.  In most circumstances, attempts have been made to control the thyroid cysts.  Thyroid surgery for a large thyroid cyst requires that the entire thyroid cyst and its lining be completely removed.  Thyroid surgery for a thyroid cyst cures the process and spares normal thyroid tissue.  Only expert thyroid surgeons should perform thyroid surgery in order to avoid the potential complications among inexperienced thyroid surgeons.

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Bonus! #5 Most Important Fact About Thyroid Cysts: Thyroid cysts which have a solid component must be analyzed from the solid component of the cyst

Thyroid cysts which have a solid component are not uniformly benign.  When an expert ultrasound of the thyroid cyst is performed and a solid portion is noted, this solid portion of the thyroid cyst should be the focus of the examination.  The characteristics of the solid portion of the thyroid cyst must be analyzed for blood flow, small calcifications and its ultrasonographic appearance.  Needle biopsy of the solid component of the thyroid cyst should be performed if there are concerns regarding its appearance in order to evaluate for the potential of thyroid cancer. 

Additional Resources

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Author

Dr. Gary Clayman, MD, FACS, FACE

Dr. Gary Clayman is one of the most experienced thyroid and thyroid cancer surgeons in the world and serves as Chief Medical Officer of the Hospital for Endocrine Surgery and Director of the Thyroid Institute, which includes the Clayman Thyroid Center and Scarless Thyroid Center in Tampa, Florida. He has limited his practice exclusively to thyroid and thyroid cancer surgery for more than 26 years, caring for some of the most complex and high-risk cases referred from across the United States and internationally. For nearly 30 years at The University of Texas MD Anderson Cancer Center, Dr. Clayman was the leading head and neck endocrine surgeon, serving as Distinguished Chair of Head and Neck Surgery and Chief of Head and Neck Endocrine Surgery. During his career, he has performed hundreds of thyroid cancer operations annually, including a large proportion of patients with recurrent, persistent, or aggressive thyroid cancer following failed initial surgery elsewhere. Dr. Clayman has authored over 217 peer-reviewed scientific publications, 35 books and book chapters, and is the author of The Atlas of Head and Neck Surgery, a global standard reference for endocrine surgery training. He has been continuously funded by the National Institutes of Health (NIH) and National Cancer Institute (NCI), holds multiple patents, and serves on the editorial boards of leading scientific journals. He is a frequent national and international lecturer on the surgical management of thyroid cancer. A Fellow of the American College of Surgeons (FACS) and a member of more than 20 prestigious medical societies, Dr. Clayman has been named to America’s Top Doctors for 19 consecutive years and Best Doctors in America for 18 consecutive years. He is widely regarded as a defining leader in modern thyroid cancer surgery and has never had a malpractice claim in his career.